The difficulties of traveling with a young baby may be greatly lessened by making certain preparations. If the baby is bottle-fed, the preparations will depend upon the length of the journey and whether or not it will be possible to have freshly prepared feedings, for each twenty-four hours, put on the train from laboratories along the way. If this is not possible and the journey is not to take more than twenty-four hours, the entire quantity of food, ice cold, may be carried in a thermos bottle. The requisite number of sterile nursing bottles may be taken or one bottle which is boiled before each feeding. Or the milk may be prepared as usual and the bottles packed in a portable refrigerator. Such a refrigerator may be bought or one may be improvised. The bottles are placed in a covered pail and packed solidly in crushed ice; this is placed in a second pail or a box with a diameter which is at least two inches larger than the inner pail and the space between the two packed firmly with sawdust. Several thicknesses of newspapers should be pressed down over the top and a tight cover fitted to the outer receptacle.

The sterile nipples may be taken in a sterile jar and a deep cup or kettle will be needed in which to warm the bottle before each feeding. It is usually possible to obtain water on the train which is hot enough for this, or cans of solid alcohol, a stand and a metal tray may be added to the traveling outfit. If fresh formulae cannot be delivered to the train, daily, and the journey is to last more than twenty-four hours, one of the proprietary foods or a powdered milk will often prove to be a satisfactory solution to the problem of feeding.

The baby will usually travel more comfortably and sleep better if he is carried in a basket. A large market basket with a handle or a small clothes basket will serve. It may be lined with a sheet or a blanket; have a small hair pillow or folded blanket in the bottom and be made up like a crib. (Fig. [173].) If this basket stands on the car seat during the day, and on the foot of the nurse’s berth at night, the baby will be cleaner, quieter and less exposed to drafts than if carried in the arms.

THE PREMATURE BABY

All of the precautions and gentleness which are necessary in the care of the normal baby, born at term, must be greatly increased in caring for the baby who is born prematurely.

As was explained in Chapter III the premature baby’s prospects of living increase with the length of his uterine life, and it is often possible to estimate this by measuring and weighing him. During the last five months the child’s length in centimetres divided by five gives the month of pregnancy, according to the following table by Dr. Williams:[[15]]

But consideration of the baby’s weight is also of importance when attempting to forecast his chances of living. A baby weighing less than 2500 grams or about 5½ pounds should be regarded, and treated, as premature, unless it is more than 45 centimetres, or about 18 inches long. This length would indicate greater maturity, and therefore greater viability than would be expected from the weight. A baby weighing less than 1500 grams (3 pounds and 5 ounces) can scarcely be expected to live.

The premature baby is not only small, but in general is imperfectly developed, having slenderer powers than the full-term baby and at the same time much greater needs. His respiratory and digestive organs are less ready to function than in the full-term baby; his muscles and nerves are feeble; his heat-producing mechanism is unstable and yet there is an excessive radiation of body heat through the relatively large area of skin.

Accordingly, the baby who has been deprived of those valuable last weeks of growth and development is small and limp; lies quietly most of the time and moves very feebly if at all. He is often too weak to nurse at the breast and may swallow with difficulty. His temperature is low, his respirations irregular and he is frequently cyanotic.